Africa Blog

Project HOPE has a long history in Africa – beginning in the mid-1960s with a visit of the SS HOPE to Guinea. Currently, our programs in Africa focus on the continuing AIDS pandemic and its devastating impact on families, Tuberculosis control, humanitarian assistance and the growing need for chronic disease education and prevention. Our blog chronicles some of the day to day triumphs and challenges associated with our health education programs and the people we serve.

We are preparing to launch the HOPE Centre project in South Africa with three community screening events - one in Zandspruit, one in Cosmo City and one in Kya Sand. These screening events will be publicized on the local radio station, through the local clinic and through other "bush communication" mechanisms! We anticipate running these screening events at the end of March.

The aim of the screening days is to help raise awareness in these communities about the growing risks of non-communicable disease (NCD) such as diabetes, cardiovascular disease and chronic respiratory disease. We also want to begin identifying people who are at risk of developing NCDs so that we can prevent its onset and refer people who need follow-up investigation to our new clinic and the new set of services that it will bring to these communities.

During the screening days we will have a nurse and a couple of community health workers who will take blood pressure, BMI and blood glucose as well as provide some basic health and nutrition education. It is anticipated that at each event, we will screen between 300-400 people.

We need your help!

Each individual screening costs approximately $3.50, which includes the nurses’ time, medical supplies and health materials. In addition we need to purchase a Gazebo and portable table and chairs that can be used. Therefore we are looking to raise a total of $5,000 to cover these costs.

Please, would you consider donating to this great cause? A $100 donation could screen 29 people!

The HOPE Centre project is located in a township called Zandspruit which is about 45 minutes away from downtown Johannesburg. It has a population of around 75,000 people with the vast majority living in shacks like the one pictured. Services to the township are pretty limited. Bordering on Zandspruit are an additional 3 townships, one of which is now formalized - meaning the government is building low-cost housing and 2 are squatter camps. So the total population in the area is around 300,000. In terms of health care they have access to one primary clinic that is staffed by a couple of nurses. Waiting times are lengthy and many people only go when they are extremely ill. Little preventive medicine is done resulting in many people developing these diseases that are easily preventable.

The HOPE Centre really is a beacon of light in this quite depressing environment. First and foremost it will educate the community about the risks of chronic diseases such as diabetes and cardiovascular diseases that are having such a detrimental effect on people's lives. Secondly, it will provide needed access to trained health professionals who can deal with the various illnesses and associated resulting complications.

Yesterday was an important day in the development of the HOPE Centre project. We had a visit from the Department of Health to the site to look at our facilities and confirm that we could go ahead with the project. I am glad to report that we got the OK, and we are now good to go. Partnering with the government is so important, particularly from the standpoint of sustainability and future handover. We are now in the process of formalizing the partnership with an memorandum of understanding that will hold all partners accountable.

So, after a long wait I can finally formally introduce you to our new clinic. Project HOPE has partnered with a local NGO called Emthonjeni Community Centre. This organization was many years ago donated a significant piece of land and buildings in what is now the heart of Zandspruit.

This building, a beautiful thatched house and outlying buildings serve as offices for a variety of NGOs working in the community. Currently, two days a week an antenatal clinic is run from the building. Project HOPE will work out of these two clinic rooms initially one day per week, expanding the services as we raise funds running the chronic care clinic. It is hoped that in time we will be able to build a newer, larger clinic on the site in the not too distant future.

So what's so unique about the HOPE Centre approach compared to other projects? This is a question that I have had to answer many times when presenting this project to potential donors. My answer goes something along the lines of this:

"The HOPE Centre approach is unique first and foremost, because there isn't anyone else in the country doing exactly this! Secondly, while some organizations are thinking about working in chronic disease, they are not thinking holistically. They think curative only (or in this case management) rather than preventive first, curative second."

That's what I think will make this project stand out - it is an integrated, holistic approach to prevent and manage chronic diseases such as diabetes and cardiovascular disease in a setting where resources are extremely limited and where people struggle to survive on a day to day basis.

The HOPE Centre will tackle chronic diseases in a number of ways:

Clinically - we will open a chronic care clinic that is staffed by a professional nurse, with additional help from volunteer specialists such as doctors, podiatrists, ophthalmologists and pharmacists. This clinic will receive referrals from the government clinic and will serve a catchment area of over 300,000 people. People will be able to receive comprehensive screening, counseling and medication for their conditions if needed.

Peer Support - Arguably one of the most important factors in managing a chronic disease, or trying to modify ingrained behaviors so that you don't develop a chronic disease is support from peers who are in the same situation. Patients who have been screened by the clinic or who have been referred to us by other partners will be encouraged to join these support groups. They will meet on a weekly basis for a period of one year. During these weekly meetings Project HOPE and its partners will provide comprehensive health education, counseling, nutritional assessments, vegetable gardening and cooking classes, physical activity assessment and classes as well as continued health monitoring to make sure the disease is under control and stable. After the one year period these peer groups will "graduate" knowing how to manage their disease well, what to do if something goes wrong, and will become "change agents" in the community - being able to encourage others not to live in a way that puts them at risk of getting a chronic disease.

Education and Screening - we will be working with the Department of Health to provide training materials and develop screening techniques that Community Health Workers can use as they go door-to-door in the communities making people aware of diseases such as diabetes, HIV, TB etc. Project HOPE will empower these Community Health Workers to be able to act as the "first line" in preventing chronic diseases in communities by educating them on the diseases, risk factors, and then helping them to identify potential cases and allowing them to refer them to clinics so that they can be seen before it is too late.

To ensure quality of the highest standards, Project HOPE will be working with the University of Witwatersrand in all phases of the project - from determining the current chronic disease priorities through a baseline survey, developing and fine tuning the interventions including curriculum development, monitoring and evaluating of the project and publishing the results in various academic and non-academic forums.

All of this is getting me VERY excited!! I hope to update you next week with some pictures of our new clinic and of the communities that we will be working in.

It’s true, people in South Africa are dying from AIDS. South Africa has the largest number of infected people living with HIV, estimated at over 5.7 million. The national prevalence rate is around 12%.

Yet there is something else going on in South Africa and across the developing world that is not receiving as much attention as it should and that is the rise of Chronic Diseases. These include diabetes, cardiovascular disease, cancers and chronic respiratory diseases.

Let’s look at some numbers from the Global Health Report to make a comparison. In 2005, over 35 million people worldwide died from chronic diseases. It is the leading cause of death and disability and currently accounts for almost 60% of deaths and 43% of the global disease burden. In the same year, 2.8 million deaths worldwide were caused by HIV/AIDS. By 2020, it is estimated that chronic disease will account for 73% of all deaths.

Chronic disease is no longer a Western problem.

Here are some facts about diabetes:

Today 300 million people worldwide have diabetes.

10,000 people die every day from diabetes - that is double the amount of people dying from AIDS.

In sub-Saharan Africa 12.1 million people are estimated to have diabetes, with only 15% diagnosed.

By 2030, 23.9 million adults in sub-Saharan Africa will have diabetes - more than the number of people that currently have HIV.

In South Africa, an epidemiological transition is taking place with a shift in disease burden from infectious diseases such as HIV and TB to chronic diseases. With the change in eating patterns, and rural to urban migration, many of the new urban poor are now encountering a “double burden” of disease. Not only do they continue to be susceptible to infectious disease, but with the availability of nutrient poor but calorically dense food, combined with a sedentary lifestyle, they are at increased risk for obesity and developing chronic diseases.

In South Africa, chronic diseases accounted for 28% of all deaths in 2002. In 2005, a study showed 51% of men and 77% of women in South Africa were overweight, a major risk factor for chronic disease, predicted to increase over the next 10 years. Between 1997 and 2004, 195 people died per day because of some form of cardiovascular disease (CVD) in South Africa. Models suggest that by 2010 there will be over 600 deaths per day in South Africa due to chronic disease. Premature deaths caused by CVD in people of working age (35-64 years) are expected to increase by 41% between 2000 and 2030. Diabetes in South Africa is an emerging problem particularly when prevention messaging and early detection screenings are very limited. Many people present themselves at clinics when they are already suffering from a complication of the disease. Access to insulin and regular blood sugar monitoring is challenging in impoverished areas. In response to the facts, Project HOPE is taking a leading role in addressing this crisis.

Since 1998 Project HOPE realized that this problem was only going to get worse and began addressing it before anyone else by providing diabetes training to health care professionals in China, India, Mexico, New Mexico and now South Africa. The HOPE Centre project is our response to this crisis in South Africa. Please check back regularly to see how we are getting on.

Mozambique

I was in Mozambique recently doing a recollection and some focus group interviews with our Village Savings and Loan (VSL) groups. It had been raining quite a bit before I arrived which made reaching some of the groups a bit more difficult. At one point we got completely stuck and had to walk a few kilometers to reach one of the groups.

We do these interviews for a couple of reasons: First, we want to measure improvement over the life of the project – in this case the VSL cycle which is 11 months. Second, through our focus group interviews we can dig down a bit deeper to answer questions like, “why do you participate in the VSL?” and “what are you going to do when you get your savings back.”

The answer to “why do you participate in the VSL” was interesting. Almost all people responded in a similar way. They said that saving at home is a lot harder than saving in a group because when you put money away at home there is always the temptation to use it for something, or help someone out if they need to borrow money. Women find saving money in the house particularly hard because in a lot of cases the men control the finances and so they might put money away, but their partner might then take it and spend it. In a VSL group people understand that they will not have access to their savings until the end of the cycle. Because there is no ready access to formal banking services, people are using the VSL program to put away all their savings because they see it as a good and safe way to secure their money.

During this visit I was also able to visit some of the health activists that Project HOPE trained on our health curriculum. They are all doing really well, and going through each of the lessons weekly with the groups. One nice thing that I saw was that there were discussions taking place as the health activist asked questions – people were engaging and debating the answers. This is a huge step forward, as in the past people were told what was right or wrong and it wasn’t acceptable for them to ask questions.

In 2011 we will be continuing to roll out our VSL program further benefiting more vulnerable households as well as implementing a new project starting before Easter. From all of us here in Mozambique we wish you a very Merry Christmas and a Happy New Year!